Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Monday, October 29, 2007

Ridge Lines

In no way is it false modesty to say that physicians are not healers. At best, what we do is to grease the way, to make conditions as favorable as possible for the body to heal itself. For without the body's amazing powers of defense and repair, nothing we do -- especially we surgeons -- would be lasting at all. The most immediate and palpable reminder of this is the process of sewing someone up, and watching what happens.

Wound healing is a wonderfully complex process, and it would be folly for me to attempt explanation in detail; mainly, because I've forgotten the pathways, the kinins and the prostaglandins involved. I'm not going to look it up again, but you can if you like. Anyone who's had an operation, from minor to a big deal, has had the opportunity to witness it. Maybe you were too sore to be in awe. But I always liked to point out the easy evidence to my patients.

I've gotten calls about red incisions (despite trying to explain it in advance.) Of course, it's necessary to separate the natural from the infected (digital photography and email have been known to save an office visit, for the technologically inclined); but all incisions get red for at least a few millimeters out from the cut. An inflammatory response, it's the process of bringing the building materials into the work site: capillaries dilate and proliferate, blood flow increases. That, and much more, goes on under the surface as well. Attracted by "injury chemicals," various cell types arrive and unload their cargo, set up lattice work, induce structural changes. The result of the influx is a gradual thickening and hardening of the area for an inch wide or more, and which carries the unofficial-official name "healing ridge." When the ridge isn't there, you know there's trouble ahead. In the very ill, in people on high-dose steroids, in the malnourished, a soft and non-pink incision is an unwelcome and unhappy harbinger.

As much as feeling the healing ridge can alarm the unexpecting, it's a sign of health, the indication that help is on the way, that work is going on to effect healing. I'd warn people. To hernia patients, I'd say, "In a few days it's going to feel like a sausage under there. You might think the hernia is back." Or, after removing a lump of some kind from some place, "In three weeks, you'll think I didn't remove it at all." It takes many weeks for the ridge to melt away. The zone of redness dims, but the incision itself gets increasingly red, and doesn't simmer down for a year or more. (It also fades after the application of vitamin E, of ear wax, and of snake-oil, singly or in combination.) It's a living monitor of how long healing is active. Given an explanation of what's going on, surgipatients get a ridge-id ringside seat from which to watch the body do its work. (A corollary is the tiredness that most everyone feels after surgery. There's lots of work going on, I'd tell them. While you're lying around feeling lazy, your body is doing the equivalent of walking around all day. Give yourself a break.)

Good point about insisting that patients take it easy and allow their bodies to heal. With our busy lives, we tend to get out of bed while still sick or go back to work before we've fully healed. And, boy, do we ever pay the price.

In a couple days I will have a total hip replacement. Yesterday, I sat through 3 hours of total hip education. Not once was the subject of letting your body heal mentioned. No, it was, "we get you up and dressed and on the next day" and ship you out in three days. Have they been talking to the insurance companies too much? Speedy discharges are all well and good, but for God sakes tell the patient it is OK to rest and heal. In the last two years, I've had five major operations, including four belly procedures. I wish I had read your article at the outset.

Useful information! I just had surgery last week for a small primary ventral hernia, and was certain that the doctor created a bigger problem when I awoke yesterday to find a cucumber-like bulge in my abdomen! After some internet research, I realise this is normal. Why, oh why, did my physician never mention it?! I'll try to stop pushing it in now...!!! Thank you for the blog!

I had hernia surgery 2 weeks ago. My doctor mentioned a healing ridge. Now it feels like a sausage under there--like my hernia came back. I was happy to see your blog telling me that this is a good sign.

I just had my thyroid removed and this was not mentioned to me before hand, luckily my surgeon had given me her e-mail so it eased my worries somewhat when she said it was normal and called a ridge line, but this post really eased my mind even more since in the back of my mind I was thinking "are you sure" :)

I had hernia surgery two weeks ago and just got back from my followup visit with the surgeon. He took one look at the "healing ridge" and pronounced that I had superior genes! I had worried for several days that something had not gone right and a second surgery would be necessary. Now my fears are twice unfounded. He did say the ridge would go away slowly... over the next 3-6 months. Until then I will just remember Mae West's line... "is that a gun in your pocket, or are you just glad to see me." :)

Thank you so much for the useful information! We just called our doctor with concerns about our son's hernia site and they said it was the "healing ridge" but gave no further information. I found this blog and am so relieved.

My son (2.5 years old) had an injury to his face 9 months ago (May 2008) which required 5 stitches in the emergency room by the ER Dr (no plastic surgeon was available to stitch him up). He still has a hard lump under the scar but a bit off to the side more that under it. It feels like a "ropey bean" to describe the texture & shape of it & it sticks out of his face. I am hoping it is the healing ridge & will go away on it's own so he doesn't need to have the scar revised. 9 months seems like a long time & it hasn't softened at all over this time, but our plastic surgeon has said children take longer to heal than adults & he says it's just scar tissue underneath that has formed. He has never used the term "healing ridge".

Is the term "healing ridge" a common term in the medical world? Neither my family Dr or plastic surgeon have ever used this term, they just say it's scar tissue. The plastic surgeon said if it isn't gone by the time 18 months have gone by then we can consider revision to remove it.

It's a common term but has a pretty specific meaning, namely the general thickening of tissues immediately below an incision in the early phase of healing. It's mostly gone within several weeks, so what you describe doesn't really fit the definition, from what I infer.

What a great informative post. Thank you so much. I am a week out of inguinal hernia repair and having periods of great pain. I was convinced the operation was a botch. But I am a pretty lean and fit person and in this case the surgeon said that it was working against me. I don't have a lot of fat down there to cushion the healing ridge, so I guess the nerves are getting irritated. I found your explanation to very much ease my worries.

I just recently had sentinel lymph nodes removed to check for any metastatizing of DCIS and there is this large lump to the front of my underarm which greatly aggrevated and somewhat alarmed me. Only when I spoke of it to my surgeon post-op did the phrase "healing ridge" come up, no forewarning was given. Your blog is the only info. that appeared under Google's "I Feel Lucky" and boy do I ever. Thank you for this helpful information. Now I can watch in true awe instead of worrying that another surgical procedure would be necessary to remove it.

I am nurse practitioner student 9 days post op from an open inguinal hernia repair. My laptop is sort of propped up on my "healing ridge" as we speak. I showed my wife your article and now she occasionly asks, "How is your sausage?" to which I answer, "We are fine, thanks for asking."My surgeon was great. A nice person, who didn't seemed too rushed to answer questions, but we never discussed the "healing ridge". This information should be on the print outs they give you when you leave recovery. Thanks the info, sir, it is greatly appreciated!

Thanks Surgeon for the post. I've had a hernia operation just over a week ago. I've been sitting here worried about infection and that the hernia has become 'undone'. But from your post it seems the redness is natural so I can ditch the anti-biotics and it looks like the healing ridge is on the rise. Got to say, some of the pain from the operation due to swelling in the scrotum, etc, has been truly awful. Fingers crossed for a full recovery. Tim.

Tim: for the record, redness is a matter of degree, and so is swelling. Whereas a certain amount of redness can be normal, and swelling of the type associated with a healing ridge certainly is, at a week out from surgery there could be other issues as well. I don't know why you're on antibiotics, but I wouldn't ditch them (assuming they were prescribed) without checking with your doctor. In fact, you should check with him/her anyway, regarding your symptoms.

I'm almost a month past having half of my thyroid removed, and I have a lovely healing ridge on my throat. My surgeon (an AMAZING man...I've endured three abdominal surgeries under his care, including a urachal cyst that had ruptured my colon and bladder and I was suffering from peritonitis when he cut me open) recommended kneading/massaging the incision line to help soften the healing tissue (and keep vigorous bloodflow to the area, too, I suspect, which also helps healing). What are your thoughts on massaging a healing ridge? (Rather than investing in "snake oil.")

I'm not aware of studies that show massage affects the healing process one way or the other. My guess is that it, and snake oil, achieve about the same results; namely, resolution over time. On the other hand, I doubt there's harm; and your surgeon might well know something I don't.

I don't think that I can add much to what others have posted except to say "thank you" for this very useful and reassuring information.I am one week post-op of an ambilical hernia. I too thought that I'd done something to cause the hernia to come back. At my post-op appt the nurse practitioner did mention the healing ridge, but didn't even give a basic explanation of what that is. It seems like such a simple thing to tell a patient in advance so they know what to expect. Again, thank you!

Ten days post inguinal hernia repair and was getting incresingly concerned about the hard lump under the incision which felt very similar to the hardness of the hernia itself, the difference being that the hernia disappeared when lying down but this lump is always there. I really thought it was a botched job and am so relieved to find your site. Why the surgeon never discussed this apparently common after effect astonishes me.Thank you so much.Paul from the UK

Thank you for taking the time to put this info. on the internet. I had to send an email to my surgeon to voice my concerns about this big walnut under my incision after gallbladder removal. I was told it probably was a healing ridge. I've had three adom. surgeries over the years and don't ever remember anybody ever telling me about this process. Well, now I know.

AMEN! Thank you for explaining this. I had hernia surgery almost 2 weeks ago and I thought - and my surgeon thought I did something to mess up the surgery. Geeze. You 'd think my surgeon would know what that hardness was. He is a wiz at laparoscopic surgery but the open -makes me wonder. My neighbor who is an RN came over and said it looks good - looks nasty to me but she said the incision looks great. Ok - ha! God Bless you for explaining the healing ridge! I wish the doctors would explain this because it freaks us out. Thanks again - Marcia

I had hernia repair done 8 months ago. The last two weeks I have experienced dull pain and discomfort in my groin. The back of my leg and bum is sore...burning sensation. I am also experiencing discomfort in my hip...almost like something is pulling in the area. No buldge....Is the Hernia back?

I have been freaking out for about a week now (I am 12 days post op) due to the increasing bulge near my old inguinal hernia. 2-3 days after the surgery I hit the peak of swelling and it has been subsiding ever since. The more swelling goes down the bigger the healing ridge looks to me...which is normal.

I found that the healing ridge is highest and widest near the old hernia site. I rationale this by saying "it's where the most work was done during surgery...so probably where the most healing needs to take place". Does this make any sense?

Freaking out about recurring hernias is no fun. I am quite confident about the surgeon/facility where the surgery was done but because I am from out of town I can't really go back for a post-op assessment. :(

What you say make sense, whiplash; but, as you'd expect, I'd add that I can't really say without looking at it. It's always best, when you have questions, to check with your surgeon or someone who can look and poke around.

It's also true that if a hernia were to recur and to be thick and unyielding, it'd suggest incarceration or strangulation which would likely make you pretty sick. So, yeah, it's nearly certainly a normal healing ridge. But, covering my rear, I can't say with certainty.

thanks so much! I am 8 days post op hernia surgery. open incision with mes for an inguinal and a femoral. I was so worried about the sausage feeling under my incision. I am glad to know it's a good thing!!! Thanks a lot!

I am just over two weeks post hernia op and have a pretty impressive cucumber which seems to have reduced a little in size over the past few days. My doctor today said that there is still some blood built up (which he saw on an ultrasound) and tried to draw it out (after giving me a local anaesthetic) but could only get a few drops. He said that it may be necessary to operate again just to get the blood out and only for cosmetic reasons so that I am not left with a bulge on one side. From your blog on the Healing Ridge (which I was greatly relieved to find) I would have thought that I just need to wait and time will bring the bulge down. Now I am bit confused. I have known my doctor for man years and have great confidence in him but he has not said anything about my "cucumber" being a normal part of the healing process.

Not knowing what it looks/feels like, I can't say why this might or might not be part of normal healing. I assume by your "doctor" you mean the surgeon who did the operation... It could be that he thinks it's a collection of blood instead of the normal healing ridge. Usually removing a blood collection with a needle doesn't work in this time frame: it takes a lot longer for the clot to liquefy to the point of being able to drain it.

Many thanks for your reply. I have another appointment in 10 days and will see what it is like then. I have no pain, feel really good and am itching to do some gentle jogging soon. The symptons from before, ie why I had the surgery in the first place, have gone.Yes, he is my surgeon (sorry if I get the terminology wrong). I am in Germany and he is both a general doctor (in his specialist area) and a surgeon for operations in the same area.

Thanks for posting on the post-surgical ridge. I have learned a little about this through two consecutive open mesh repairs of an inguinal hernia. The first was done about 1 year ago. After the initial swelling went down, the ridge was still apparent but never seemed to go away. 8 months post-op, my (1st) surgeon confirmed that it was a recurrence--pretty rare with a mesh repair. Went to a different surgeon to get it "re-repaired." In my first post-op visit with the new surgeon, he said the initial mesh was loose and ballooning. He tightened the existing mesh and put additional mesh near the site to reinforce a larger area. He drew me some nice pen and ink pictures of what he did, which was actually very helpful. Anyway, I'm 5 weeks post-op from this second repair and I still have a pretty stubborn ridge/buldge, and it balloons a bit when I put my hand on it and cough--makes me nervous. I do hope the ridge subsides, the surgeon made it sound like it should be about gone by now, (my last visit was 3 weeks ago) so I'm starting to get a bit nervous that I may have pulled the darn thing loose again. Might be time for another visit, although he didn't seem very concerned about it three weeks ago.

I had an open abdominal myomectomy five weeks ago and I have a 'ridge' or swollen 'shelf' or 'sausage shape' all along the five & a half inch incision. Underneath the incision feels hard & the incision is still a little tender. Below the incision is swollen too, but I'm more alarmed at the swollen shelf that looms over the incision. I am on the small side (107lbs) so the ridge/shelf looks rather strange on my body, as I didn't have excess fat to get trapped in the incision, which could be causing the bulge. My surgeon/consultant hasn't shed much light on it and I'm concerned it won't go away without further surgery. I'm also a little unsure of what you mean by 'healing ridge'. Do you mean hardening underneath the incision, or swelling (in a sausage shape) above it?I'd be grateful for your thoughts on this matter.

Milla: Unable to examine it, I can't say specifically what's going on with you. But your description sounds like what I was discussing: the healing ridge. It can take much longer than five weeks to go away. Absent other factors, like redness, fever, pain, etc, I'd think the odds are that's what it is and that it will eventually go away.

But any opinion based only on a blog comment isn't to be considered accurate; you need to stay in contact with your surgeon.

Thank you for your reply & for providing some insight on this issue. I will be seeing my consultant again in two weeks time, although so far, he hasn't explained what has caused the ridge. In the meantime, I was wondering if you could explain, in general terms, what causes a ridge to form & visibly bulge over an incision? Is it because the area underneath the incision has internally hardened? And do 'healing ridges' gradually disappear, as the internal hardening softens over time?

I had my gallbladder remove and my surgeon also repair an umbilical and supraumbilical hernias. He did not used any mesh to repair. He just close the hernias. He did this through my belly button only. It has been almost 3 weeks since my surgery and I on top of my belly button I have a big hard ball. Do you think that what I have is the healing ridge that you described on your blog? I have no real pain. Some times I feel a little burning sensation when I have been doing too much activity, so I stopped what I am doing an rest and I feel better. My doctor says to give it time, that it will go away. What do you think?

I think the doctor who did the operation and who has examined the lump has a much better idea of what it is than I possibly could.

All I can say is what I said in the post: I told my patients that in two or three weeks you might worry the hernia is back because of the lump that will form there; in three weeks you might think I didn't remove it at all. It's three weeks, and you're worried that the hernia is back.

Thank you for putting me at ease with your insightful post. I am an orthopaedic surgeon who just got a hernia repair 10 days ago. I thought perhaps the mesh was folded up when I felt the healing ridge! Instead of trying to protect ourselves by dwelling so much on the unlikely worst-case scenarios, perhaps we may better serve our patients by giving them a good idea of what to expect. Being under the knife myself has given me an invaluable perspective.

Hi! I would just like to say that I came across this article this evening while looking up information on my healing ridge. I didn't truly understand why my surgeon wanted me out of work another week. I didn't argue, I had pre-surgery hernia pain, and I've got some good post-surgery pain going on a week and a half after and figured it was solely the pain levels and my functionality because I'm not walking too well just yet. She did, however, encourage me to go to a social event today so long as I didn't overdo it and took it easy. That wasn't a problem. What shocked me was how entirely exhausted, physically and mentally (though the second was partly from the meds) I was after just a few hours of some standing, mostly sitting. I wondered at this even as I got home, sat on the couch, and began drifting in and out of consciousness.

However, the last part of your article here makes a lot of sense - that even while I'm doing nothing, my body is doing a full day's work and then some. It's something we forget about the healing process. I'll keep that in mind over this next week as I am beginning to get back to physical activity and working on walking decently again. Thanks - I really needed that reminder!

I recently had open surgery for an inguinal hernia and just found out about the healing ridge and the scar is right on my beltline. Is there an average healing time for this because this is really uncomfortable. Besides the fact that I wasn't told about it prior to the surgery or I would have chosen laproscopic surgery.

Thank you so much. I can stop worrying about something that is apparently normal and healthy. I am 13 days out from inguinal hernia repair. The "healing ridge" has just made it's presence known and I thought the worst. Following up with my surgeon next week, for good measure. Thanks again Doc.

I too had become apprehensive about the ridge that had formed on the left half of the incision three weeks after my inguinal hernia repair. Had the mesh unattached and rolled up? Thanks, Doctor, for easing my mind.

Hi! True to what you wrote, 3 weeks post op a laparoscopic ventral hernia repair w/ mesh, I thought my hernia had come back, or I had a seroma. My surgeon said it was the hernia sack and could take months to dissolve, his nurse mentioned a healing ridge, which I had not heard of. I came home,googled and found this blog. :) I noticed after reading many of the posts, they mention healing ridge and open repairs of hernias. Does/can a healing ridge form after laparoscopic hernia repair with mesh? Thank you so much for your help and insight.

I was told post - surgery (April 6) that I had an INDIRECT (ie Congenital) Hernia.... This was on my left side.... Since the body is generally symmetrical, I was wondering of this means I am likely to have the same defect on my right side as well -- and am likely to develop a hernia there as well? There is no protrusion there at present -- but I had none on the left side for the first 44 years of life despite the defect. Thank you.

Good question, and, interestingly, it turns out that, since hernias are more common on the right, when a person has one on the left the chances of getting one on the right are higher than the other way around.

On the other hand, only around 15% of people who have one get another on the other side, % for left sided) so it's not something to worry about much. And, as you suggest, if it took 44 years, you might be okay, vis a vis the right side.

Incidentally, it's nice that you're aware of the more-or-less true fact that indirect herniæ are congenital and direct ones are more considered due to straining, etc.

From your 05/19 post: On the other hand, only around 15% of people who have one get another on the other side, % for left sided) so it's not something to worry about much. And, as you suggest, if it took 44 years, you might be okay, vis a vis the right side.

Me (anon - Steve) I missed the % for those who have their first [only - I hope] hernia.... I always like to know the percentages. Also, absent a protrusion -- can a physical exam by a doctor see if the congenital defect is present -- whether or not a hernia manifests itself [ie can they feel the opening] or is the exam only capable of confirming a hernia once it is present. Thank you very much.... Aside, my healing ridge is smoothing out V E R Y slowly... I'll be at 7 weeks post op on Friday (May 25th)... Most lit says 4 to 6 weeks... I'm going on 7 and at the present rate it won't fully flatten until 3 months or more. I know its normal,necessary, even good - a sign of healing - but my own experience is outside of that 6 week window I see as I peruse the net.

I don't have a lot of use for statistics, in that whatever happens to the individual is 100%. I think it's possible feel a somewhat lax internal ring, ie the hole through which a hernia protrudes.

But absent an actual hernia, it doesn't mean much. I don't know of any surgeon who'd operate to tighten a relaxed ring when there's no hernia, no symptoms. Of course the fact that I don't know of any doesn't mean there are none. But I wouldn't.

three weeks post a bilat open inguinal hernia repair, no problem except feeling stretching sensation on sitting or standing for more than 1hour or so,feels like lying down, on lying feels as if something trying to come up,better after few minutes,is mesh related edema the cause,how long it may take to resolve?

By some measures, three weeks is when tissues are at the most abnormal postoperatively. So I wouldn't be worried about tightness at this point, unless there are other signs, like redness, heat, fever, etc.

It's hard to say how long it might take; anywhere from another month or two to a few more than that. As always, it's best to raise your concerns with your surgeon, who'll know more about what exactly was done.

Hello, I had my hernia surgery 3 weeks ago (mine became an open surgery as my bladder was accidentally punctured during the laproscopic surgery and the bladder was fixed along with the old-fashioned fix of the hernia (inguinal on the right side). I am a female and was told that this happened because of the presence of scar tissues as a result of previous c-sections.

I was perfectly fine till yesterday - I do not work and was doing moderate work (such as climbing up and down, sitting, standing, cooking some dinner but not any heavy lifting etc). Yesterday was the first time I tried my hands on driving and ever since I have developed a sharp pain on my hernia site. It is bad especially when I am sitting, sleeping or putting pressure on the abdomen area.

Is this normal ? Is this the result of scar tissue acting up ? Can I resume my normal activities or should I wait some more ? Will the pain go away ? I also have some bulge in the area as I was worried about the recurrence. Could this be a healing ridge also ?

This is indeed very helpful - explains the 'sausage', the tiredness, the scar. i have question though about pain around the site. 3.5 weeks after an open mesh femoral hernia repair, i have stitch -like pain in my stomach muscles up that side, and also pain around the pubic bone. The tummy muscles also feel rather ridged and lumpy. i'm a slim female so its easy to see/feel. is there an obvious reason for this? thanks if you get time to answer this.

Sometimes, depending on the repair, a stitch could be place in or very near the pubic bone. As to the rest, it's hard to say: effect of "favoring" one side when there's pain, maybe, causing stress on other muscles.

But for specifics it's best to ask the surgeon, since I really can't know from this far away.

Your blog on the healing ridge is remarkable! I am a hospital coder and read charts all day and I have NEVER heard of a healing ridge...I also worked in a wound care clinic and never seen the surgeon mention 'healing ridge'. Now that I am 12 days postop of an open ventral hernia repair w/ mesh, I have developed the 'healing ridge' as the nurse told me via phone call today. Surgeon nor hospital staff forewarned me about this... I knew I had a seroma 3 days postop I was leaking serous red/brown fluid from the op site. After 7 days of Bactrim no more leaking fluid from site however I still had the 'KNOT' anterior to the wound. Until I read your blog I was mentally preparing myself for a potential 'postop complication seroma surgery'. I can't thank you enough for your insight and experience from the operating theater. I remain

I had an umbilical hernia repair done exactly two weeks ago. It was a small hernia (dime to nickel sized) so my surgeon used sutures rather than mesh. I have a hard lump under my belly button, making it appear to stick out (even more than before and now I really have an outie). The lump is hard, not like the squishy hernia. Is this the healing ridge? On average, how long does it take it to go away?

I really can't make a specific diagnosis without an exam; if you're concerned you should have your surgeon evaluate it. As I said in the post, though, the healing ridge is generally firm, and I used to warn people that for a while they might think their hernia has returned. I'd tell them the ridge, the firmness, can take several weeks to resolve.

I am sooo glad I found this post! I went to see a surgeon for a hernia that needed repair and it turns out during the post op follow up, I realized he repaired a hernia I didn't even know I had!! My first operation was on Oct 25 and done lapriscopic. Well needless to say I just got the hernia that was giving me trouble repaired exactly a week ago. It was done open and no mesh was used. Yesterday I noticed a hard lump around both operation sites. It was also pretty sore and tender to the touch. Needless to say I was pretty frantic thinking my surgeon had once again let me down. After reading this, I am totally hopeful the surgery was a success and I will rest easy until I have my post op checkup Monday. This post has been most helpful:)

Yes I am. I went to him due to pain I was experiencing stemming from a ventral hernia right above my belly button... When he operated, he repaired an umbilical hernia I didn't even know existed! To my dismay, once the bandage came off I realized I now had an innie belly button but the painful bulge above it was still there... When I went for my post op appt. I showed him the area I was referring to as painful. It was at that point that he said that he would have to do another surgery to repair the ventral hernia because he had not caught it the first time around. Basically I had the operations a month apart. This is why when I felt the bulge this time I was super worried...

I am eight days out from an open repair of a right inguinal hernia, using mesh. I was completely unprepared for the amount of pain for the first five days. And just today I found myself in tears having discovered the hardened lump underneath the incision site. I was absolutely convinced that my surgeon was an idiot. Thank you SO very much for your incredibly insightful post regarding the healing ridge. I agree with so many other commenters that physicians could save their patients much worry and mental anguish by preparing us to expect the hardening of the healing ridge. It is quite easy to understand and would only take a couple minutes of their time. Your post has convinced me that I need to not rush my recovery but learn to rest and let my body work its magic. And you've given me peace of mind that my healing process is very much on a positive track. I will sleep easier tonight, having run across this fantastic post. THANK YOU for what I consider an excellent and compassionate piece of helpful information.

Just found this today and you have saved me a trip to the hospital A&E dept, I had my inguinal hernia repair just under 3 weeks ago & yesterday discovered this healing ridge and to be honest sh*t myself as I thought the hernia had recurred or something drastic had gone wrong as I had NO explanations at all about what would happen to my body after surgery abd have had to rely entirely on the internet to get me through the 3 weeks so far, Thanks for putting my mind at rest also the surgeon mentioned that it was a new process using NO stiches to hold the mesh in ?? which has not helped my worrying about the slightest little thing.

I had umbilical surgery two weeks ago to the day and it looks like the hernia is back the swelling is in the same place the original hernia was to the left of the belly button. I did not have any swelling at all and then all the sudden this happened at 2 weeks. It feels a little tight when getting up out of chair have been doing alot of walking. I know you can not see what I am talking about but will this healing process make it look just like the hernia again it is a little hard under it. Surgeon look at it last week and said it looks great. Never mentioned this healing ridge it looks like the hernia is back. Any thoughts??

What an interesting and well written blog. 11 days ago, I had my gallbladder removed. The surgery was a breeze and my recovery has been swift. As a very active triathlete-in-training, I was thrilled to even resume running just 6 days post-op!

It was a bit disconcerting, however, to feel those lumpy, bumpy spots underneath my 4 incisions. Your post helped me understand what is happening just below the surface, with cells "bringing materials to the work site" to heal the body. What an ineresting process.

My surgeon assures me they will diminish or disappear completely over time. Thanks again for writing an article everyone can understand.

I had umbilical surgery five weeks ago. My hernia was very large (cue ball size) and was laparoscopic with a large mesh. My incisions healed nicely but my belly button is now a smaller hard lump (but flat) and still a bit sore. I called my surgeon and she said not to worry its normal with out any further explanation. I am so glad I found this page, you rock! Given the large size of my hernia how much longer should I expect it to take for the ridge to go soften and go down?

I am grateful to come across this. I was just a bit concerned about my incisions for my appendectomy as there is a "hard" ridge especially on the top incision, and it's still tender. Surgery done on May 25. I am also grateful that you mention rest as I get on myself for "napping" after work since this surgery. Thank you.

I had open incisional hernia repair with mesh Nov 15.2012, with hx of lap cholecystectomy in May 2012. I have lost 40 lbs since the November surgery and it is July 1 2013. My knot "healing ridge" has decrased from a small softball to the size between a baseball and a golfball. I know you mentioned it would take around a year to dissolve however, I am concerned about the 'what if' factor. As I had to move (by myself) in April 2013. How would I know if I have a recurrent hernia or if it is the healing ridge? I look like I am pregnant...ok well at least a baby bump..which it not flattering when someone comes up to rub the 'baby'. LOL. What symptoms should I look for if it is a recurrent hernia? Also, with the weight loss I am concerned about the mesh tension...do you think that would be an issue. I have not done situps or crunches so I do not know. Thanks in advance, By the way love your book Cutting REMARKS

Andy, the only way to know for sure what's going on is to have a surgeon (your surgeon) have a look. Whatever it is, it doesn't sound at all like a healing ridge.

I guess it depends on how the hernia was repaired. If it was large, and a large mesh was placed, it's possible that it's just protrusion outward of the mesh but not a true hernia. Or, it could be recurrence.

Thank you, by the way I am a female... I use my nickname a lot. The surgeon said I had a large size mesh placed under the fascia to 'prevent' recurrence but even I know better about recurrent hernia's. So if I the tension is loose and if I had a recurrent hernia... how can I get a plastic surgeon to 'tag team' with general surgeon to perform a panniculectomy. I have lost over all 100lbs in 2 years...all gained immediately after giving birth to son -post partum depression, OSA...put the pounds on me. Apologies...I am thinking if I can meet med nec on the panniculectomy and repair of the knot...what is the risk if I urge for both surgeries in same operative setting. Too risky? I am thinking I will need the panni done anyway so why not do both? Your opinion please?

Having inguinal surgery 5 weeks ago and experiencing that lump underneath the incisional site led me to your well written article. My question...the skin above the ridges are purple in color and raised along the entire top incisional line and partially below the incisional line 1/4 to 1/2 wide. Purple????

Hard to know without seeing it. During healing, incisions, and the nearby skin, go through various normal color changes.

Another possibility is that it could be forming a keloid, which is a thickened scar. They can be permanent, and unattractive, but not significant. If injected with steroid while forming, the growth can be diminished.

Whenever there's a postoperative concern, the best thing is to check with your surgeon.

Sid, remarkably valuable post of yours which clearly identifies a widespread omission in postoperative advice. I have added it to my customer service questionnaire after my tag and prolapse repair (along with 1) immediate post operative pain relief via suppositories should be default mode NOT tablets for abdominal surgery- I lay in agony for hours before an empathetic nurse came on duty....2) a tightly rolled and taped towel is invaluable for support of your wound during movement, coughing,retching etc)

Im really glad to see this. I had a inguinal hernia since i was 14. Im not 27 and finally got it done but for a moment i was thinking my dr. didnt fix it. Thank u sooooo much for posting this. Im seeing my surgeon today so he can remove the staples and im pretty sure he is gonna say the same thing. It's been 2 weeks since my surgery but having this "bridge" it's quite uncomfortable. Any suggestions on what to do with this feeling?

Thank you Dr. Schwab, your article left me feeling much better about this hard lump that feels like my old hernia. I really feel that unnecessary worrying can increase stress and slow the body's natural healing ability. So thank you very much for helping me to relax and in doing so helping me to heal faster. What a great Doctor=)

I have a question. I suffered an injury a few weeks ago and had to get two very tiny stitches. The cut was not that deep and the doctor originally was not even going to put two sutures in but he couldn't get it to stop bleeding and decided to. The stitches came out fine and it is filling in well but there is the bump line (the ridge) still there. I know it will be a while before that heals. He claims there probably will not be a noticable scar or any real visible scar at all because the cut was not deep. Is this possible, does that sound right? What does a tiny ridge on the fact look like?

Jack, if a cut doesn't go all the way through the dermis, i.e. the skin, there's a good chance it'll heal without a visible scar; or that it'd be very hard to see.

I don't know how to answer your last question. I assume you meant "face" instead of "fact," but even so, a healing ridge tends to go away completely; what's left will depend on various factors, including the size and depth of the cut as well as its relation to natural skin lines.

Thanks for posting. I had an abdominal myomectomy 3.5 weeks ago and my ridge is quite hard. I wasn't too alarmed as my doctor warned me of it, but it's good to know that it's normal and a sign of healthy healing.

I just had a quick question. I know this is fairly old but I had a c section four weeks ago and it has healed nice... The incision is great but right above the whole incision is a ridge like over hang.. I am not a big person and do not have excess fat like that.. It is soar to the touch and feels bruised I have been putting pressure and massage to make it go back down to no avail. Is this normal will this go away? Can you email me asaft@live.ca? I am very curious. I can forward picture of this mass of skin if need be.. But will this go away and is this normal

Amanda: first, it's always best, when you're concerned about your incision, to have it looked at by your surgeon. I can't specifically diagnose what's going on.

As a general comment, which may or may not apply to you, I can repeat what I said in this post: it's normal to have a firm ridge in the area of an incision that can be quite prominent, and which may take three months or more to go away.

I have saw the surgeon and she states that by massaging this ridge above the s section scar it may improve the appearance. But she did not state whether or not this would dissipate. It goes the whole length of the section scar directly above. Do you believe cold compress or warm Compress with massage would bring down this type of due or am I stuck with this

Assuming it's the usual healing ridge, it'll go down with more time whether you massage or not, whether you use heat or cold or nothing at all. It's a process that happens internally and which proceeds at its own pace.

On the other hand, none of those measures will harm anything; so if you want to do any of them, have at it!!

Thank you. It's almost poetry to see such a full and precise description of the healing ridge (I've recently had an iguinal hernia operation) and very reassuring. Also spared my Dr another query and I'm sure she'd be grateful too.

thanks for the helpful info. i had a testicle removed last week and was worried about hard lump that suddenly developed under the incision. how long do you recommend patients stay out of swimming pools and hot tubs after hernia surgery, etc. to avoid infection?

Best to check with your surgeon about timing of such things. It depends a little on how the incision was closed. And if you ask ten surgeons you'd probably get at least five answers, mostly based on not much.

I also developed a healing ridge after colon resectioning surgery it happened last Saturday. I was not going to call the doctor and wind up back in the hospital I thought I hurt something. I did go back and see the surgeon on Monday that is when I first heard healing ridge but really no explanation--- I was getting worried when I did not see is going down in size. I read your article and it has helped me a lot understanding this will take a while to disappear. Sounds like letting it heal itself over time is the best medicine no creams or massages while it is so new. Thank you for your help.

Im pleased to hear the sausage type lump is normal. Im just concerned how long it will take to disappear. I had myomectomy 2 weeks ago..a horizontal bikini line incision. Its very unflattering and uncomfortable. How long does it take to dissapear?:-(

Hi can a healing ridge occur when the ventral hernia was closed laparoscopically? My surgeon did do a laproscopic procedure but had to make a incision over the defect to bring the mesh in the intra abdominal space. Then he closed the defect from top. (Maybe partially open surgery)

The healing process is the same for all incisions, and it leads to a thick and firm zone where the healing is going on. The extent to which there's a noticeable "ridge" depends on the size, and to some degree, of the location.

It's normal for there to be palpable firmness where there is active healing. Whether a given finding is due to normal healing or something else isn't something that can be decided online. Whenever there are concerns about what's going on in the postoperative period, it's best to be in touch with the surgeon who did the operation.

Thks for the quick response. I am 5 days post op for laproscopic/partially open ventral hernia repair at Walter reed. I have some bit of pain but started to feel a hardness in the area of the hernia. Ur blog and response put me at ease. I'm seeing the surgeon in a week.

Bless you for taking time to explain these things. I had abdominal surgery last year after a bleeding ulcer left a lot of scar tissue that blocked the passageway from duodenum to small intestine. The scar runs from my sternum to navel. Scar looks great but the grotesque, protruding ridge makes me think the surgeon sewed his upper arm under my skin. It makes me feel horrible about my appearance. To read your description that this is supposed to be like this makes me feel slightly less horrified by the appearance of my belly.

4Dailys: A healing ridge forms within a couple of weeks after surgery, and melts away over a period of a few months. If the protrusion you describe is a year old, as I infer from what you wrote, that's probably not what it is. Could be a hernia; or what's called "diastasis recti" which is a wide separation of the abdominal muscles. You might want to have your surgeon have a look.

Dear Dr. Schwab: Surgeon said that I do have a hernia and diastasis recti, but the neither are something he was at all concerned about. He told me that I was cleared to do all physical activity I wanted to do and if, some day, the hernia became painful or something I could not live with, he would open up my abdomen along my existing scar, push things back where they belong with some mesh and sew me back together again. I said I have no intention of ever going through abdominal surgery again, so my belly lump and I are going to have to learn to live together. Thank you so much for answering my question and lighting a fire under me to go get it checked rather than worry about it.Rebekah

I am two weeks out from debulking surgery and ostomy reversal for ovarian cancer, which I am thrilled to share went very well.My surgeon mentioned healing ridge, and I found your post by Googling. Thanks ever so much, she was thorough, but your information is also very helpful. I have a lovely healing ridge, for which I now am most grateful, and will watch with greater interest and gratitude as my body responds and performs its complex magic over the next few months!

Thank you for the poetic visual of the wonderful healing properties of the body, my body. I am 4 weeks post-op for an umbilical hernia (open procedure w/mesh, it was a big tear). I just had my 4 week visit and I told my doc I feel like I have a bread-pan in my belly. He laughed, he thought I said bed-pan. I have a large very hard ridge-line the entire length of my 8' incision and it is wide. So very different than my c-sections or hysterectomy.I was assured by my doc that I was healing beautifully,I still have plenty of swelling, he told me to continue to take it easy. He then explained to me in detail just how invasive my surgery was, I appreciated his candor.Your blog-post put me in a better frame of mind and in appreciation of this my body who I felt had utterly betrayed me. I will try to be more patient with myself. Thank you, and peace to you.

Thanks for this post. It's really reassured me after having an open myectomy two weeks ago. I'm amazed at how my body is healing but was also a bit worried after coming across the ridge above my scar. It's nice to know after reading this that its all part of the healing process so I can relax. Thanks for all of your good work. x

As I wrote, the healing processes involved in producing a "healing ridge" are gone within several months, and ought to be fully quiescent after a year. But whereas what you are feeling probably wouldn't be called a healing ridge, it might not be anything abnormal. The best way to find out is to see the surgeon who did the operation.

This is a great post ive been worried about this sausage and googling it about a week , think you should be given more info on this when after op dischaging seems alot worrying on same hope i recover welliguinal hernia mesh nearly 3 weeks agoChelle

I had open inguinal hernia surgery 4 weeks ago. It was very large and the incision is about 4-5 inches. At the end of two weeks, the surgeon removed the stitches and said that other than minor swelling under the incision it all looks great and I should resume my excerciing schedule which included stretching and treadmill. He said that I should not worry because all was in place and strong. the next day I exercised but no where to prior levels and that night I felt a lot of pain, discomfort and swelling. The next morning the swelling was completely gone and all looked good until a few hours later as the swelling below the incision started to increase and be hard and look like a cucumber as you describe. When I lie down it does not go back the way it did prior to surgery. I am now at 4 weeks and I experience the same process every day of being perfect in the morning until 10-11 am. The incision looks good and is not red or warm. The surgeon said all is holding well and this must be some fluid build up that will go away. He wants to see me at 8 weeks .It is either the healing ridge because it is hard, fluid or a new hernia. I feel better each day but it still looks the same at 4 weeks and it is hard to determine the degree of less swelling one day to another.I would appreciate your thoughts.

Without being able to examine the area, and not knowing about how the operation was done, I really can't comment much. I'll say it's unusual for the swelling to be coming and going, and that's not how I'd describe a healing ridge. So it certainly needs to be followed.

I had a laparoscopic appendectomy 6 weeks ago and my surgeon also didn't tell me about a "healing ridge". I have a lump under only one of the three access sites. Your blog has been very helpful because similar to others, I immediately thought that it was incisional hernia needing another surgical repair. However, I have been unable to see any photo examples of healing ridges to compare to the lump that I have. Searching "laparoscopy, lump, incision" type of key words just bombards me with photos of incisional hernia. Do you have any that you could post? Or possibly any references?

Sorry, I don't have any pictures. The fact is, though, that the healing ridge is much more notable by feel, since most of what's going on is below the surface, and it doesn't necessarily protrude much above the skin. It's a thickening and firmness that travels the length of whatever incision there is, and extends a couple of centimeters, give or take, outward.

For a laparoscopic incision, it'd be more cubic or spherical in shape.

What a relief to read this. Thank you so so much. I had a open small umbillical hernia repair 2 weeks ago today. Had sutures only surgeon said as very slim and small hernia, mesh not appropriate he said I would very much feel and be aware of it, this made me cringe!! Keep thinking that with sutures only I need to really heal well. People saying oh will that hold without mesh i hope so no choice! My surgeon briefly mentioned as very slim lady would feel permanent internal stitches but I have no idea what that would feel like. staples out 3 days ago all looking wonderful. Today had a feel (paranoid hernia going to come back) and my god I have a mini sausage / cucumber going on, oh my hernia must be back. My hernia was a stuck out very painful lump awful this feels totally different, its under the skin flat firm ridge an upturned smiley face following my sad face belly button neat scar. Phew what a relief. I dont have follow up for a month but will now relax now so much more. I will stop asking friends family postman strangers to clinically examine and give their opinion on recurrence considering non are certified surgeons funnily enough! would like to also thank yourself and others about tiredness. I went for my 1st proper outing to the theatre to see a show which a friend paid for my birthday. The fold up seats were a killer and couldnt sit in there for 2hrs straight. I have tingling stretching and slight tugging sensations around the site but I think this is to be expected. I was exhausted and by 10pm needed my bed im normally constantly energised so was shocked. I was weepy this morning and slept on off all day thinking I have this ridge so tired my body failing me again.whys it all gone wrong. Now I understand my poor belly is very busy, of course it makes sense. What we dont see internally we dont understand the processes. Now I feel really proud that actually im healing and I do work properly. I do have anxiety about recurrence as I am a health care professional and for a small lady man handle people as such, my job is physically demanding. I actually lifted something way too heavy at work heard a loud pop laughed until 5 minutes later I was not laughing. The radiologist I was with u/s me and we could see a lovely hernia. What an idiot. To everyone else thank you for sharing, recover well, I can not thank you enough for this blog, my surgeon was fab but very very little if any information was given as to recovering, what to expect and what is normal. You are an angel x lorrie

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.